Fax and email privacy waiver - Cannon Memorial Hospital - cannonhospital 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by reading the waiver carefully. This document outlines your consent regarding the transmission of medical records via fax and email.
3. In the signature field, provide your signature or that of your personal representative to indicate consent.
4. Next, print your name clearly in the designated area to ensure proper identification.
5. If applicable, indicate your relationship to the patient in the corresponding field.
6. Finally, enter the date on which you are signing this waiver to complete the form.

Start using our platform today for free to streamline your document editing and signing process!